Purpose: To evaluate the laboratory results and prognostic factors of poor clinical outcomes in microbial keratitis cases over 15 years at Saint Louis University. Design:Retrospective cohort and trend study.Methods: Microbiological and clinical information from culture-positive cases seen at Saint Louis University from 1999-2013 were reviewed retrospectively. Statistical analyses were used to determine microbiological and antibiotic susceptibility trends. Prognostic factors of poor clinical outcome from the literature were used to create multivariate regression models to describe our cohort.Results: Gram-positive organisms predominated (48%), followed by Gram-negative organisms (34%) and fungi (16%). The most commonly isolated organism was Pseudomonas aeruginosa (21%). Oxacillin-resistant rates of Staphylococcus aureus and Coagulase-negative Staphylococci were 45% and 43%, respectively. Only the proportion of Pseudomonas changed significantly over time (p=0.02). The only antibiotic found to lose efficacy over time was gentamicin for Grampositive organisms (p=0.005). Multivariate logistic regression analyses revealed that major complications were associated with large ulcers (p<0.006), fungal cases (p<0.001), and co-morbid ophthalmic conditions (p<0.001). Poor healing was associated with large ulcers (p<0.001) and fungal cases (p<0.001). Lastly, poor visual outcome was associated with large ulcers (p<0.01) and age > 60 years (p<0.02).

Background: Females comprise 1/3 of general surgery residents, 1/4 of surgical faculty and 10% of full professors. Inadequate sponsorship is one proposed mechanism for this decline. This study evaluated letters of recommendation (LOR) among applicants applying to a complex general surgical oncology (CGSO) fellowship. Methods: Linguistic analysis of LOR for CGSO applicants was conducted. Demographics of authors and features of the LOR were extracted. Differences by gender of the applicant were analyzed. Results: Among 340 letters, 67% were written for male and 33% written for female applicants. Males authored 84% of letters reviewed. Female authors used more grindstone adjectives than males (3.61 v 2.90). However, this difference was seen only among letters written for male applicants (3.82 v. 2.73). All other linguistic features were similar, aside from mention of physical appearance which was significantly more common in letters written about female applicants (4% v. 1%). Conclusions: Female authors write substantively different letters than males. Physical appearance is a small but important difference in letters for female applicants.

Purpose: To compare the infectious contact lens–related corneal ulcer (CLRU) and non-CLRU cases at Saint Louis University. Methods: Retrospective review of corneal ulcer cases identified by search of the ophthalmology and microbiology department databases between 1999 and 2016. Results: Six hundred seventy-seven cases of corneal ulcers were identified, of which 46% were CLRU. CLRU cases were seen more commonly in younger patients (P<0.001) and women (P=0.03) than non-CLRU cases. Many of the infections were vision-threatening as defined by central/paracentral location (73% CLRU and 71% non-CLRU [P=0.60]) and large size of ulcer >2 mm2 in 36% CLRU and 51% non-CLRU (P=0.002). Causative pathogen in cultured CLRU was predominately Pseudomonas species (44%, P<0.001 vs. the non-CLRU group), other gram-negative (6%), gram-positive (33%), fungi (13%), and Acanthamoeba (5%). Comparatively, cultured non-CLRU was predominately gram-positive (64%, P<0.001 vs. the CLRU group), gram-negative (26%), and fungi (11%). The combined oxacillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus isolates were 35% and 34%, respectively. Despite the progressive increase in the number of corneal ulcers seen, the annual trend for any one particular organism for either CLRU cases or non-CLRU cases did not change significantly. Conclusions: Most of the cases were non-CLRU. CLRU was disproportionately associated with Pseudomonas species and non-CLRU with Staphylococcal species. Fungal infections were predominately caused by filamentous organisms in both groups. Acanthamoeba keratitis was exclusively associated with CL use.